community health

Louisville is among cities harnessing the collective power of community-based organizations, local government, and nonprofits to become a more equitable place where everyone can thrive.

Two Metro Louisville government leaders driving these efforts were guest speakers for Humana’s celebration of the life and legacy of the Rev. Martin Luther King Jr. This year’s theme: Unity in Community.

Maria Hughes, Humana SVP and Chief Inclusion and Diversity Officer, with Mayor Greg Fischer at the Lean Into Louisville kickoff event.

Kellie Watson, Louisville’s first Chief Equity Officer, and the Rev. Dr. Vincent James Sr., the city’s first Chief of Community Building, discussed the state of our nation and the city of Louisville. The speakers also highlighted Humana’s partnership with Lean Into Louisville, a city-wide effort that will provide an unprecedented series of presentations, conversations, activities, and art exhibits to explore and confront the city’s legacy of discrimination and inequality.

Ms. Watson provides strategic, visionary planning and oversight to advance racial equity throughout Louisville Metro Government. She oversees the Departments of Human Resources and the Human Relations Commission.

Watson is leading the city on an “equity journey,” joining national partners and other cities to learn how government can make a difference. A top goal: Rooting out structural racism, institutional racism, and implicit bias. This requires raising awareness, investing in marginalized communities, and helping people navigate difficult terrain together.

She shared a startling fact about how black income continues to lag behind white income: “Black wealth is at $5.04 for every $100 that a white family has. That’s $5 for every $100. Those are the inequities that government helps perpetuate that we need to fix.”

“How does government break down the institutional barriers around racism?” she asked. “How does government break down those systems that continue to perpetuate the barriers that keep people from reaching their full potential? And as we all know, government has perpetuated a lot of those barriers throughout history.”

“Governments,” she observed, “must be intentional about fixing such things.”

Each Louisville Metro Government department now has a “racial equity liaison.” These high-ranking leaders have authority to represent issues effectively within their areas.

To evaluate proposed policy changes, Ms. Watson and her team use a “racial equity toolkit.” It provides questions to help define desired outcomes, highlight relevant data, and identify community stakeholders so they are represented.

There were 8,500 victims of hate crimes in the United States in 2017. Ms. Watson gave a powerful, personal account of Louisville’s efforts to reduce these crimes, noting that recently she and her family have been victims.

Rev. James also spoke about being called to serve, saying he was horrified and inspired to act after a triple homicide near his church. He arrived at the scene to find two young people whom he had mentored among the dead.

“I said I never wanted to see another young person die in our streets,” he said. “I asked what would happen to them if I don’t help. I volunteered for everything.”

James left his corporate career to become Chief of Community Building. He focuses on the city’s comprehensive public safety strategy, supervising departments including the Office for Safe & Healthy Neighborhoods, Public Health & Wellness, Youth Detention Services, the Louisville Zoo, and Parks & Recreation.

He serves as the Faith and Community Based Coordinator in the Office for Safe & Healthy Neighborhoods, which works to address the root causes of violence through community engagement and programs such as Pivot to Peace and mentorship.

James is also pastor of Elim Baptist Church in Louisville’s Parkland neighborhood, and he has been involved in multiple non-profit community-building initiatives.

He said the work that he, Watson, and Mayor Greg Fischer are doing is “helping us understand how we got here, that we didn’t just arrive at this point in time in our country, but it was through systems and government policies and individuals who wanted to keep things the way they were without allowing others to have full access to opportunities. Years and years of divesting from our communities have led to what we see.”

The goal, he said, is to bring equity to all communities.

“Why is it that if you lived in one zip code versus another, there is a 12-year lifespan gap?” he asked. “That’s injustice.”

“When you give people jobs and hope, and they have the opportunity to receive an education, it changes history. That’s the work that we’re in. We’re in the people-changing business.”

After a Q&A session with associates, Maria Hughes, Chief Inclusion and Diversity Officer, closed the session with a quote from Dr. King: “We must accept finite disappointment, but never lose infinite hope.”

Learn more about Lean Into Louisville. Learning opportunities will be available throughout Louisville.

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Bruce BroussardIn a series of LinkedIn Influencer blog posts, Humana President and CEO Bruce Broussard shares insights and ideas about the future of health care and discusses the importance of working together to improve the health-care system as well as our own health and well-being. His latest — Doing more with less: health care inspiration from the developing world — is reprinted below. To see all of his blog posts, click here.

I had the opportunity to attend the World Economic Forum in Davos, Switzerland. It’s always an amazing experience to learn about new ideas in health and other societal matters from around the world. As a strong believer in the importance of lifelong learning, Davos is a place where there is always something new to learn.

This year what struck me the most was how innovators in underdeveloped countries are overcoming economic challenges and lack of infrastructure to meaningfully advance health care delivery. Despite limited resources, these people are providing ingenious solutions to health care issues, some of which have actually put their countries further along than the U.S. in scaling digital health solutions.

Here’s a quick recap of three meetings I had with individuals who are advancing health care delivery through innovative approaches that leverage a wide variety of care access points, mobile technologies, and less-specialized clinicians. These solutions transcend economic and infrastructure challenges.

 

Integrated training and technology, distributed access points, and unconventional providers can be brought together to improve access to care. At the top of this blog, you’ll see a photo of Dr. Dixon Chibanda and me. Dr. Chibanda is the founder of The Friendship Bench and a psychiatrist from Zimbabwe, and he is one of just 12 psychiatrists practicing in Zimbabwe, a country of over 16 million. He’s an amazing individual whose Friendship Bench provides a relaxed and natural setting where people can speak comfortably about what’s bothering them.

Dr. Chibanda shared that he uses grandmothers as providers, using mobile apps to teach them to provide basic mental health services. He said grandmothers bring a level of empathy to the process that has been instrumental in getting people to open up about their problems. This successful program is not just in Zimbabwe; it’s been launched in the United Kingdom and New York City.

Mobile apps and transportation are changing health care in Venezuela. We’re all sadly familiar with the crisis in Venezuela. But despite the challenges they face, Venezuelans are innovating around access to care.

I sat down with Dr. Andres Gonzalez, Director of Venemergencia, which provides telehealth and a unique form of house calls to enhance care. For example, Venemergencia’s doctors and nurses, with their diagnostic equipment, use mopeds to see their patients. Combined with a mobile app, patients can schedule appointments, and doctors are able to access patients’ medical records to provide personalized care. It’s a great example of boldly delivering care locally without the constraints of brick-and-mortar clinics.

Telehealth is transforming care delivery in challenging rural markets. Sangita Reddy, Managing Director of Apollo Hospitals, is using technology to help people who live in rural parts of India and struggle to access care.

In 2018, she and her company facilitated 2.4 million telehealth visits in India and nine other countries in which Apollo operates. During my conversation with Sangita, she spoke to the benefits of telehealth as a means for specialists in metropolitan areas to connect with their patients living with complex diseases. Primary care physicians and nurses benefit as well, because the work advances their training.

 

As I reflected on these learnings, it reminded me of underdeveloped countries going directly to cellular telephone technology, skipping landline technology. I experienced this firsthand, as my father’s career began with AT&T, installing landline switches in those brown cement buildings located in every U.S. city. In the later stage of his career, he was installing cellular technology in underdeveloped countries that had no telecommunication, bypassing the less-agile and building-dependent landlines. Fast forward 20 years, and mobile has become the preferred technology.

Could this foreshadow the evolution of the traditional health care system, which is more institutional and expert-dependent, making it more difficult to access and more costly? The future system — with expanded access points through less-trained individuals aided by technology — will come, but it requires the current system to actively invest in the technology infrastructure, governments to change public policy, and companies to transition to new business models. I hope we will embrace the transition more quickly than we embraced the conversion from landlines to cellular service.

Access to care is a global issue, but solving it happens on a local level. A report from Oxfam found that “every day, 10,000 people die because they lack access to affordable healthcare.” Solving for this is a global imperative and especially hits home for those of us in the health care industry. It requires bold and innovative approaches that meet people where they are, ever mindful of the non-health challenges that impact their access to care.

I’d be interested in your thoughts. What assumptions about health care do we need to challenge? In your community, how are innovators helping to improve access to care?

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Humana and the University of Houston recently teamed up to officially launch the new Humana Integrated Health System Sciences Institute at the University of Houston (the Humana Institute).

The Humana Institute is designed to unite the existing colleges of Nursing, Pharmacy, Social Work and Optometry with the university’s new College of Medicine. Humana previously announced how its $15 million gift will help defray start-up and operational costs for the College of Medicine, as well as fund endowed chairs for each of the five health colleges.

The event, which was attended by a wide variety of UH students, faculty, and community members and was covered by the Houston Business Journal last month, commenced with a panel discussion with the following leaders from Humana and the University of Houston:

• Renu Khator, University of Houston President
• Roy Beveridge, MD, Chief Medical Officer, Humana
• Stephen Spann, MD, Vice President for Medical Affairs and Founding Dean of College of Medicine, University of Houston

“Health care isn’t a solo sport, it’s a team sport. An integrated team approach where doctors, nurses, pharmacists, social workers and more are all working together for the patient will increase the value of healthcare. We must also address major health disparities that exist today while recognizing the importance of social determinants of health,” said Spann. “This new partnership with Humana enhances the University of Houston’s ability to achieve its mission of improving the health and healthcare of our community, our city and beyond.”

Dr. Beveridge addressed the importance of moving from a fee-for-service reimbursement model to a value-based reimbursement model. “The payment model for all government reimbursement is going to an outcome-based, quality-based set of metrics.” He continued, “As we move to this world of paying for outcomes, then everything (social determinants of health such as food insecurity, social isolation and loneliness) that Dr. Spann just talked about is an imperative. If you are reimbursing for outcomes but thinking in a fee-for-service mentality, you lose efficiency and don’t bring the quality of care that each one of these patients deserves.”

UH-Humana: a strategic partnership

“I would like to thank Humana for their generosity, vision and commitment. There’s so much synergy and compatibility in our missions. How do we make our nation a better place? We are here for the people to empower communities,” said Khator. “The structure of this partnership with five Humana endowed chairs in our five health professions colleges will force collaboration. We will come together to solve problems.”

“Launching the Humana Integrated Health System Sciences Institute at the University of Houston marks a critical milestone in our strategic relationship,” said Tray Cockerell, Director, Strategic Relationships, Office of the Chief Medical Officer, who is responsible for evaluating and leading strategic relationships that further Humana’s strategy of integrated care delivery and value-based care adoption.

In this role, Cockerell partners internally across Humana to drive population health outcomes and to integrate the operations and outcomes of Humana with the University of Houston and other academic and community partners.

“We are partnering on cutting-edge projects that will have a measurable impact on health education and on population health,” Cockerell said. “The number of students and University of Houston faculty and staff who attended truly reflects the importance of this partnership and the significance of the Institute.”

“We’re extraordinarily proud and thankful to partner with the University of Houston,” said Worthe Holt, MD, Vice President, Office of the Chief Medical Officer. Dr. Holt is responsible for operations in the CMO office. “This partnership is truly a part of our vision. If we can positively impact health care in Houston, we can scale up and do so elsewhere. We’re going to implement a very innovative approach and train a whole new generation of health care providers who can take this body of knowledge and make a difference in the health of our nation.”

Driving integrated care

At the launch event, there was a second panel discussion that focused on how the Humana Institute would be designed to address today’s health care challenges.

The panel discussion, which featured Dr. Spann; Lamar Pritchard, Dean, College of Pharmacy; Dr. Holt; and Kathryn Tart, Dean, College of Nursing, focused on the future of inter-professional education, social determinants of health, and value in health care.

During the panel, Dr. Holt spoke to the increasing impact of social determinants of health; the population health approach to health care delivery; and the robust research and clinical expertise that Humana brings to the partnership.

Dr. Spann also commented on the wealth of experience that Humana brings to the table and the way Humana integrates care. Said Dr. Spann, “We will benefit substantially from the practical, hands-on knowledge our Humana colleagues have and will share with us.”

Dean Tart said the partnership will “work for the betterment of our patients while moving them toward a healthier life and a peaceful recovery.” She also said the partnership would ensure that nursing students learn to address social determinants of health, and she noted how Humana’s Bold Goal would help drive the partnership.

During the panel, Dr. Spann spoke to how the new school will address the challenges of medication non-adherence and the high costs associated with it. He also cited the importance of taking learnings to the next level and Humana’s “state-of-the-art approach to primary care” that can be leveraged to improve quality of life and health care outcomes. Representatives from both organizations also emphasized how data transparency and interoperability will be critical areas of development, as well as how technology can drive preventive medicine.

Dr. Holt envisions the partnership will help prepare students to operate in an integrated care model: “So whether it’s a doctor, nurse, optometrist, pharmacist, or social worker, we would like to see all of them leverage their expertise to change the way we deliver health care and achieving better outcomes in a more equitable fashion as well as a more cost-efficient fashion. In a value-based model, when it’s done correctly, you can improve health, cost and quality. Responsibility, accountability and opportunity will help change the health of our communities for the underserved and the disadvantaged and those who depend on federal programs.”

Students compete to improve care

The launch event also hosted a health care poster competition depicting ideas for integrated care delivery. According to Cockerell, “I was really impressed with the depth of the research abstracts and the quality of the poster presentations from the students. These young men and women are brilliant and will be foundational to the continued evolution of our health care system.”

Last September, both organizations disclosed how they also intend to collaborate on a number of other opportunities, including

• Adjunct professorships and teaching opportunities for Humana subject matter experts
• Opportunities to partner in shaping curricula in a wide range of topics, including value-based payment, home-based care, population health, data analytics and more
• Partnership on research and publications
• The establishment of value-based care clinic labs for University of Houston health sciences students and medical residents
• Internships and rotation programs to provide practical experience

While the partnership is still in its early stages, Dr. Beveridge says both parties see great potential to improve health. “When we looked at the University of Houston’s commitment to serve the people around the community, combined with their belief in education for all parts of the health care system, we knew that we had to be a part of this,” said Dr. Beveridge. “The more we can educate, we believe that it’s going to foster an unleashing of talent over the next several years. We’re very excited to see how this is going to work out.”

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The Humana Foundation, philanthropic arm of Humana Inc. for the past 38 years, has announced the details of its 2019 Community Relations initiative in Louisville. Through this initiative, the Humana Foundation awarded $2.4 million to Louisville-area organizations in 2018, with slightly more than $1 million of that in grants of $25,000, $50,000 or $100,000.

For 2019, the program has been revised to reflect learnings from our inaugural initiative in 2018:

• The application period will begin on January 24 and conclude on February 11, with grants announced in April 2019.
• In an effort to encourage collaboration among nonprofits, grassroots organizations, and a multitude of other sectors, the Humana Foundation intends to fund as many collaborative efforts as possible – with joint applications from two or more organizations.
• Grants will be for $100,000, $50,000, or $25,000, with collaborators sharing funds they receive.

Individual organizations will still be able to apply for the grants, and may still receive grants, depending on the quality of all applications received.

“Our first year of this Community Relations initiative in 2018 went very well; more than 170 Louisville-area organizations applied for grants, and we were able to award 32 grants,” said Walter D. Woods, CEO of the Humana Foundation. “That being said, we are looking forward to encouraging collaboration in the nonprofit community with this year’s approach to funding. The 2019 program also aligns well with our strategy which emphasizes co-creation in communities, where leadership, culture and systems work to improve well-being for all.”

Selection criteria

The program in 2019 will fund initiatives that address social determinants of health by providing critical safety net services and/or those that make Louisville a more appealing place to live for all, including:

 Nutrition and food security – help increase the community’s supply of sustainable, nutritious food sources
 Shelter – focus on the homeless population, housing for today, and also stable housing for the future
 Personal safety– focus on people facing danger or harm on a regular basis (domestic abuse, violence, unsafe home environments)
 Health care services – meeting the health care needs of those who don’t have regular access (e.g. those without insurance or who are under-insured, helping people access/afford medication/treatment)
 Built and natural environment – focus on improving both our physical environments (e.g. improved lighting, enhancements to sidewalks to make them more accessible, etc.) and the natural environment (e.g. tree planting, beautification, support of parks)
 Arts and culture – focus on organizations enriching our community’s well-being through arts and culture
 Education and early childhood development – focus on helping people develop their cognitive, social, and linguistic skills

Special consideration will go to those applications that:
o Propose initiatives that require collaboration across two or more organizations, such as multiple nonprofit organizations, government organizations, academic institutions, etc.
o Propose initiatives with a strong focus on inclusion, diversity, equity, and belonging, breaking down barriers that keep all Louisville citizens from engaging the many services and opportunities our city has to offer. This includes working to make individuals in marginalized populations feel more included, connected and welcome in our community.

Organizations interested in applying for one of these grants will do so from Thursday, January 24, through Monday, February 11. The Humana Foundation expects to announce the recipients of the grants in April. Interested organizations may access the online application here. Once again in 2019, Humana employees in Louisville will have an opportunity to help the Humana Foundation decide where the grants will go, through an employee vote.

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The lack of funding and support to alleviate the social determinants of health (loneliness, food insecurity, lack of transportation) are making it very difficult, especially for seniors living with multiple chronic conditions, to improve their health. In a blog post for the World Economic Forum, Humana President and CEO Bruce Broussard examines what the U.S. health care system can do to better address the challenge.

Read the blog here.

 

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